Towards standardisation of evidence-based clinical care process specifications

Area of Science:

• Health Informatics
• Clinical Process Modeling
• Healthcare Standardization

Background:

• Healthcare systems face challenges with inconsistent terminology and descriptions of clinical care process specifications.
• This ambiguity hinders effective communication, data recording, and the integration of advanced health systems.

Purpose of the Study:

• To develop a taxonomic characterization of clinical care process specifications.
• To resolve confusion surrounding the terminology and description of these specifications.
• To provide a framework for consistent and computer-interpretable clinical documentation.

Main Methods:

• Analysis of existing literature on clinical care process specifications.
• Extension of the De Bleser approach for characterization.
• Development of a taxonomy based on purpose, core elements, and interrelationships.
• Evaluation using a case study on Type 2 Diabetes diagnosis and treatment in the UK.

Main Results:

• A novel taxonomy for characterizing clinical care process specifications was developed and presented.
• Each specification type was successfully characterized by its purpose, core elements, and relationships.
• The taxonomy was validated through a case study, demonstrating its practical application.
• The framework effectively distinguishes between previously interchangeable terminologies.

Conclusions:

• The developed taxonomy provides a clear framework for understanding and standardizing clinical care process specifications.
• Standardization ensures consistent, high-quality patient information recording and computer interpretability.
• This approach facilitates the integration of Learning Health Systems and reduces terminological confusion in clinical practice.